How Exercise Can Be as Effective as Antidepressants in Reducing Depression

jogging in fog or mist

Exercise: An Effective Treatment for Depression

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Experiencing a post-workout mood boost is common, and a recent review highlights just how impactful this effect can be. Simple activities like walking or gardening can alleviate depression symptoms as effectively as psychotherapy or antidepressants.

“This research reinforces that exercise is a viable option for individuals suffering from depression, showing that it can rival the effectiveness of psychotherapy or medication,” states Andrew Clegg from the University of Lancashire, UK.

A prior Cochrane Library review in 2013 discovered that exercise alleviates depression symptoms comparably to standard treatments like antidepressants and cognitive behavioral therapy (CBT), which focuses on modifying thought patterns and behavior.

Consequently, health authorities advocate regular exercise for depression management. The UK’s National Institute for Healthcare Excellence (NICE) suggests engaging in aerobic activities such as jogging for ten weeks, typically in conjunction with other therapies for optimal results.

Since the 2013 review, numerous clinical trials have surfaced, prompting the Cochrane Library to embark on an updated review. “This new review nearly doubles the existing evidence base from the previous publication,” comments Clegg, a co-author of the review.

Clegg and colleagues reviewed data from 69 randomized controlled trials involving nearly 5,000 adults diagnosed with mild to severe depression or showing elevated depression symptom scores. Their analysis focused on 57 trials where participants were assigned to either an exercise group or a control group receiving no treatment.

Trial methodologies varied significantly, but usually directed participants to maintain a routine of low to moderate exercise—like gardening or brisk walking—compared to more vigorous activities like sprinting or soccer. Yoga and stretching were excluded, as these often incorporate meditative or breathing practices, which detracted from the study’s emphasis on pure physical activity.

The research indicated that exercise modestly reduced depression severity, characterized by feelings of sadness and disinterest in social activities.

“Clinically meaningful improvements were observed—individuals reported noticeable changes,” remarks Brendon Stubbs from King’s College London, who was not part of the review.

Furthermore, the team analyzed ten of the 59 trials that compared exercise to CBT and five trials involving participants on antidepressants devoid of an exercise component. Results indicated that, on average, regular exercise proved equally effective as these treatment modalities. “There was no significant difference in outcomes among the three,” emphasizes Emily Hird from University College London, who also did not partake in the study.

The research highlighted that light to moderate exercise outperformed intense workouts. This may be linked to higher adherence rates; as Stubbs explains, “Strenuous exercises often lead to dropout, thus diminishing the observed benefits.”

While the precise advantages of exercise remain under investigation, Stubbs suggests multiple potential mechanisms. Group activities could enhance social well-being, and acquiring new skills might boost self-esteem, fostering positive life changes.

Studies indicate that muscle-released chemicals, known as myokines, help reduce inflammation, which may exacerbate depression. One particular myokine, brain-derived neurotrophic factor, is known for promoting new brain cell growth, potentially aiding in the reconfiguration of negative thought patterns, as asserted by Stubbs. Interestingly, Clegg’s team discovered that resistance training, which generates more myokines, was more effective than aerobic workouts alone.

Collectively, these findings advocate for exercise as a depression treatment modality. However, since participants were aware of their group assignments, some gains might stem from placebo effects, where expectations influence symptom relief. Additionally, the majority of studies had limited participant numbers, which may impact reliability, according to Hurd.

Hurd advocates for larger studies to investigate optimal exercise types tailored for individuals and their unique challenges. “Currently, we lack clarity on who benefits most from different exercise forms,” she asserts. Individuals with severe depression might struggle to maintain exercise routines and may find more relief through CBT or antidepressants, both of which exhibit effectiveness akin to exercise in managing depression. Furthermore, some individuals may respond preferentially to specific activities based on their depression’s root causes.

Nevertheless, evidence consistently reveals the benefits of exercise for both mental and physical health. “Activities such as running, gym workouts, Pilates, and yoga all impart various positive effects. The most crucial aspect is to engage individuals in activities they enjoy,” concludes Stubbs.

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Source: www.newscientist.com

Antidepressants Can Cause a Diverse Range of Physical Side Effects.

Different individuals may respond better to certain antidepressants based on their side effects.

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The side effects of antidepressants can differ significantly, ranging from weight fluctuations to alterations in blood pressure. Medical professionals need to consider these factors when selecting the most appropriate medication among the numerous options available.

About 10% of individuals in Europe and the US utilize antidepressants to address symptoms including depression and anxiety. Withdrawal symptoms may not be as prevalent as assumed, yet some studies indicate physical side effects associated with these medications. The specific side effects linked to each drug, however, remain unclear.

Diving deeper into the research, Toby Pillinger and his team from King’s College London examined data from 151 randomized controlled trials and 17 reports from the US Food and Drug Administration. These studies encompassed 30 different antidepressants, assessing their efficacy and side effects relative to a placebo over roughly eight weeks for various mental health conditions.

“The strength of these studies lies in their placebo-controlled and randomized design, allowing us to confidently attribute the observed differences to the medications,” Pillinger states.

The analysis revealed that certain medications were linked to weight loss, while others caused weight gain. For instance, maprotiline was associated with an average weight gain of approximately 1.8 kg, whereas agomelatine was linked to an average weight loss of about 2.4 kg.

The research additionally indicated that fluvoxamine led to an average decrease in heart rate of 8 beats per minute (bpm), while nortriptyline raised it by 13 bpm. Notably, nortriptyline also lowered systolic blood pressure (the pressure during heart contractions) by 3 to 7 millimeters of mercury (mmHg), whereas doxepin elevated blood pressure by nearly 5 mmHg, which may have wider health implications. “For every 1 mmHg increase in blood pressure, the risk of stroke rises by 1%,” remarks Oliver Howes, also from King’s College London.

Other medications like paroxetine, duloxetine, desvenlafaxine, and venlafaxine have been linked to increased cholesterol levels. It remains uncertain if these side effects intensify, diminish, or stabilize after the initial eight-week period.

Although observational studies have raised concerns regarding the potential impact of antidepressants on electrolyte levels, particularly sodium—as it may influence heart rhythms—”our study indicates that sodium isn’t an issue at all,” Pillinger comments.

In the UK, over 92 million antidepressants were prescribed last year, with approximately 85% being either sertraline, mirtazapine, fluoxetine, amitriptyline, citalopram, or venlafaxine. Among these, four exhibited relatively favorable profiles for various evaluated factors; however, amitriptyline was noted for increasing body weight, heart rate, and blood pressure, while venlafaxine was found to elevate heart rate, blood pressure, and cholesterol levels.

“This information is immensely useful for both physicians and patients,” remarks Mahyar Etminan from Epilytics, an epidemiological consulting firm in Vancouver. “This data can be integrated into an application, enabling doctors to identify which medications to avoid for individuals with high cholesterol or cardiovascular issues. It provides physicians with greater flexibility in selecting the most suitable antidepressant for their patients.”

Pillinger mentions that his team is developing a digital tool that features a drop-down list of common side effects associated with antidepressants, assisting healthcare providers in determining which medications to avoid or whether reducing dosage could be advantageous. “The essential goal is to find the most appropriate drug for each individual and tailor prescriptions accordingly,” Pillinger explains.

However, John Ioannidis, a researcher at Stanford University, cautions that their findings could be skewed if only studies demonstrating side effects were included. Some research may not have reported any adverse effects, thus excluding pertinent data from the meta-analysis.

He also points out that patients typically remain on antidepressants for at least eight weeks, often for several years. “If such an impact exists over a more extended period, it necessitates different long-term studies to validate its relevance,” Ioannidis asserts.

Pillinger acknowledges the possibility of bias but believes they have compiled the majority of relevant data. He recognizes the need for long-term study analysis and is in the process of conducting it, mentioning that around 75% of trial participants have been white. Nonetheless, he believes the trends identified will likely become clearer over extended studies and may extend to other demographics.

Prior research has indicated that some antidepressants, such as venlafaxine, are associated with long-term blood pressure increases. He also notes that rapid weight gain might persist. “Once weight is gained, it becomes challenging to lose it again,” he states.

However, due to the effectiveness of antidepressants, those worried about side effects should not discontinue their medication, according to Howes. “This is a nuanced issue and an individual decision that considers your unique risk factors and benefits. If concerned, consulting with your physician is advisable.”

Topic:

  • Medical drugs /
  • Depression

Source: www.newscientist.com